TABLE 5.

Recommendations for Critical Limb Ischemia: Endovascular and Open Surgical Treatment for Limb Salvage

2005 Recommendations		2011 Focused Update Recommendations	Comments
Class I
For individuals with combined inflow and outflow disease with critical limb ischemia, inflow lesions should be addressed first. (Level of Evidence: C)			2005 recommendation remains current in 2011 focused update.
For individuals with combined inflow and outflow disease in whom symptoms of critical limb ischemia or infection persist after inflow revascularization, an outflow revascularization procedure should be performed.53 (Level of Evidence: B)			2005 recommendation remains current in 2011 focused update.
If it is unclear whether hemodynamically significant inflow disease exists, intra-arterial pressure measurements across suprainguinal lesions should be measured before and after the administration of a vasodilator. (Level of Evidence: C)			2005 recommendation remains current in 2011 focused update.
Class IIa
	1.	For patients with limb-threatening lower extremity ischemia and an estimated life expectancy of 2 years or less or in patients in whom an autogenous vein conduit is not available, balloon angioplasty is reasonable to perform when possible as the initial procedure to improve distal blood flow.54 (Level of Evidence: B)	New recommendation
	2.	For patients with limb-threatening ischemia and an estimated life expectancy of more than 2 years, bypass surgery, when possible and when an autogenous vein conduit is available, is reasonable to perform as the initial treatment to improve distal blood flow.54 (Level of Evidence: B)	New recommendation